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ST. L C!E COUNTY FLA. ,
Declaration of Domici~e and- citizenship
TO THE STATE AND COUNTY TA8 ASSF.gSOIt,
gt Lua 1 e OpUNTY. FIABIDA
Thin is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in
accordance, and in conforanity with Chapter 222, Section 222.1?, Florida Statutes.
I was formerly a legal resident o#,~~~-~~~4~4-~1n------------------------------_-, _--.Self ~~----------------
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A,.~i I e~,~idr,cl at Route 1 - - ----- ------ ------ --_---. however. I have changed my domicile
-- ism .m H,~, day of
to a:.3 am Aad have b°ea a bona tide resident of the Stays of Florida since.---_-- -- -1Q --- --- - --------
---------, 19_-dQ, and I reside at-_-3E].H-D1O8,otter-~utsa~ia------------------------------
-----------~-~-u-~t --------- t8teeet and Number)
Fort Pierce - St. Lucie _____ _ ~:-__ ___~„~ty, Florida,
and this statement is to be taken as my declaration of dtizenahip, actual legal residence and domicile in
the State of Florida. _
(Insert bare any vert+~t facts. sncb as sa{e a~ yert~r or abna~ . o~~~uLhm~at aS employm~at at
former domkile, semo~al of famib to near domidle. pt~reew
.,
llpplying for homestead
i~
914
FILEL' A~;D REC R!'ED
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.~•~ ~ g wit1~ al~er r'ealuirameaita e~f a ~a1 arrasiden# of thisdreaa when flue regiatrattOn books reopen,
I F[JItTHEIi CF.IiTIFY that I have no intentiatt to ratura to my former domicile, and I intend to remain
~ ~ATt. PtltrOA -----, R~ir- in.c~, ~, ~~~
o1L~T IA• QZI~.~asl
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